November 9, 2015 – The DCRI’s Monique Anderson, MD, and colleagues examined outcomes for African-American cardiac arrest patients in neighborhoods across the United States.
Survival rates for out-of-hospital cardiac arrest (OHCA) are significantly lower in neighborhoods with a higher percentage of African-American residents.
A new study by the DCRI’s Monique Anderson, MD; Eric Peterson, MD, MPH; and colleagues from other institutions examined care and outcomes for OHCA patients by neighborhood races across the United States.
The results were presented Monday at the annual Scientific Sessions of the American Heart Association in Orlando, Florida.
Previous research has documented racial disparities in survival rates for OHCA patients. Bystander cardiopulmonary resuscitation (CPR) has also been shown to be lower in predominantly African-American, poorer neighborhoods. Until now, however, it was unclear if these discrepancies were associated with the racial demographics of the neighborhood where the patient experienced cardiac arrest.
In this study, Anderson and her colleagues analyzed data from the Resuscitation Outcomes Consortium, a network of emergency medical services (EMS) systems and hospitals that was created to conduct clinical research in the areas of cardiopulmonary resuscitation and traumatic injury.
The researchers assigned patients to geographic tracts based on the location of cardiac arrest, then grouped patients within neighborhoods based on the percentage of African-American residents living in each tract: less than 25 percent, between 25 and 50 percent, between 51 and 75 percent, or more than 75 percent. In total, 23,685 patients who experienced OHCA between 2008 and 2011 were included in the analysis.
Compared with neighborhoods with lower percentages of African Americans, OHCA patients in neighborhoods that were more than 75 percent African-American were less likely to be older, male, have an initial shockable rhythm, arrest in public location, or a have the arrest witnessed by a bystander. As the percentage of African Americans in neighborhood increased, the percentage receiving bystander CPR and AED treatment also decreased.
EMS arrival times were shorter as the percentage of African Americans in neighborhood increased, but the percentage with return of spontaneous circulation was lower. After adjustment, OHCA in neighborhoods with a higher percentage of African Americans had lower rates of survival to hospital discharge compared with neighborhoods with less than 25 percent of African Americans.
Overall, the researchers found that patients who experienced OHCA in neighborhoods with high percentages of African-American residents have lower bystander treatments and survival rates. They also found that survival rates were similarly worst in African-American neighborhoods, regardless of the individual OHCA patients’ race. African Americans, whites, and Hispanics have similarly worst survival in neighborhoods that have a high percentage of African Americans.
Additional efforts are needed to improve outcomes for OHCA patients in these neighborhoods, the researchers concluded.